Intradural Extramedullary Spinal Metastasis of a Kidney Cancer: Case Report

Objective To report a case of intradural extramedullary metastasis originated from a kidney neoplasm. Metastases in this topography occur in a low frequency, especially considering that the primary tumor was located along the urinary system. Case Report Amale adult begins to present with pain in the lower limbs and develops flaccid paraparesis of the pelvic limbs, also attacking the control of the sphincter. The patient had a previous history of right nephrectomy due to a kidney neoplasm. After investigation with imaging exams, ametastatic lesion was found to be the source of the symptoms. The patient was surgically treated by the neurosurgery team of the hospital. Conclusion Cases like this are not common, and considering the low incidence of these cases and the nonspecific symptoms, such as pain, we do not always come up with the hypothesis of a metastasis in this topography. The surgical treatment, although it is a palliative feature, has an important part inmaintaining the performance and the quality of life of the patient.

Alterações motoras em crianças e adolescentes pós-cirurgia de tumor intramedular: estudo retrospectivo / Motor changes in children and adolescents after intramedullary tumor surgery: a retrospective study

Introdução: Os tumores intramedulares são raros e correspondem a menos de 10% das neoplasias do sistema nervoso central. O crescimento tumoral pode comprimir feixes nervosos e resultar em perda da função motora e sensorial. A abordagem cirúrgica é o principal pilar de tratamento e visa à máxima ressecção tumoral com preservação da função. A reabilitação destes pacientes é individualizada se analisarmos os déficits funcionais e prognósticos. Objetivo: Analisar a idade e sexo dos pacientes, tipo e localização do tumor, tratamento cirúrgico e tratamento oncológico dos pacientes com tumor intramedular. Descrever as alterações motoras decorrentes desse tratamento. Método: Estudo retrospectivo realizado no Instituto de Oncologia Pediátrica através de dados de prontuários de janeiro de 2013 a dezembro de 2016 de pacientes com tumor intramedular. Dados analisados: idade ao diagnóstico e no momento cirúrgico, gênero, diagnóstico e localização do tumor, tipo de tratamento oncológico, cirurgia realizada, sequela pré e pós-cirurgia, indicação de coletes ortopédicos e tempo de uso. Não houve necessidade de aplicação do Termo de Consentimento Livre e Esclarecido por ser um estudo retrospectivo. Resultados: Foram selecionados doze prontuários de pacientes. A média de idade dos pacientes ao diagnóstico foi de 10 anos e 8 meses e média de 32 dias até a abordagem cirúrgica. Sete pacientes eram do sexo feminino e cinco do sexo masculino. Todos os pacientes foram submetidos a laminectomias, sendo três submetidos também a protocolo quimioterápico e radioterápico, e dois a protocolo quimioterápico. Dois pacientes foram orientados a usar colar cervical e dois orientados a usar colete ortopédico. Todos pacientes apresentaram alteração da marcha e diminuição de força muscular nos grupos pré e pós-cirúrgico. Conclusão: A idade média dos pacientes ao diagnóstico de tumor intramedular foi inferior a 11 anos, com predomínio do sexo feminino. Os diagnósticos oncológicos e as localizações tumorais foram variados. Sete pacientes evoluíram com deambulação independente após atendimento fisioterápico. A indicação de colares e coletes cervicais precisa ser mais estudada e sistematizada.(AU)

Introduction: Intramedullary tumors are rare and account for less than 10% of neoplasms of the central nervous system. Tumor growth may compress nerve bundles and result in loss of motor and sensory function. The surgical approach is the main pillar of treatment and aims at maximum tumor resection with preservation of function. The rehabilitation of these patients is individualized if we analyze the functional and prognostic deficits. Objective: To analyze the age and sex of the patients, type and location of the tumor, surgical treatment and oncological treatment of patients with intramedullary tumor. Describe the motor changes resulting from this treatment. Method: Retrospective study conducted at the Pediatric Oncology Institute through data from medical records from January 2013 to December 2016 of patients with intramedullary tumor. Data analyzed: age at diagnosis and at the time of surgery, gender, diagnosis and location of the tumor, type of cancer treatment, surgery performed, pre and post-surgery sequelae, indication of orthopedic vests and time of use. There was no need to apply the Free and Informed Consent Term because it is a retrospective study. Results: Twelve patient charts were selected. The mean age of the patients at diagnosis was 10 years and 8 months and mean of 32 days until the surgical approach. Seven patients were female and five were male. All patients underwent laminectomies, three of which were submitted to chemotherapy and radiotherapy, and two to chemotherapy protocol. Two patients were instructed to wear cervical collar and two oriented to wear orthopedic vest. All patients presented gait alteration and decreased muscle strength in the pre and post-surgical groups. Conclusion: The mean age of the patients at the diagnosis of intramedullary tumor was less than 11 years, with a predominance of females. Oncological diagnoses and tumor sites were varied. Seven patients evolved with independent walking after physical therapy. The indication of necklaces and cervical vests needs to be further studied and systematized.(AU)

Metástase espinhal intradural e extramedular: relato de caso / Intradural and Extramedular Spinal Metastases: Case Report

Metástases espinhais extramedulares e intradurais são peculiares e correspondem a pequena porcentagem dos casos de tumores da coluna vertebral. Os pacientes normalmente apresentam dor e sintomas neurológicos na primeira apresentação. A imagem por ressonância magnética (RM) é crucial para confirmar a suspeita do diagnóstico. Em geral, a manipulação requer tratamento paliativo representado por radioterapia e/ou cirurgia, para evitar futuros déficits neurológicos. O objetivo do autor é apresentar um caso incomum de metástase espinhal de câncer de mama em uma paciente de 41 anos de idade, com doença sistêmica controlada.

Intradural extramedular spinal metastases are peculiar. They correspond to small percentage of spinal tumors cases. Patients ordinarily present pain and neurological symptoms at the first presentation. Themagnetic resonance image (MRI) scan is crucial to confirm a diagnosis suspicion. On the whole, its handling requires a palliative management represented by radiotherapy and/or surgery to obviate future neurological deficits. The author's aim is present an unusual spinal metastasis of the breast cancer in a 41-year-old female patient with controlled systemic disease.

Neuroblastoma in an adult: Case report / Neuroblastoma en un adulto: Informe de un caso

El neuroblastoma es el tumor maligno sólido extracraneal más común en niños. Sólo el 10 por ciento de los casos se diagnostican después de la primera década de vida. Presentamos una paciente afroamericana de 23 años, con una masa paravertebral en T3-T5, múltiples lesiones en los cuerpos vertebrales y una lesión expansiva en la región parietal derecha. El estudio inmmunohistoquímico (negativo para CD99, CD20, CD3 y desmina y positivo para cromogranina, sinaptofisina y NB84), confirmó el diagnóstico de neuroblastoma. La paciente fue sometida a 12 ciclos de quimioterapia recibiendo VAC (vincristina / doxorubicina/ cyclofosfamida) intercalada con ICE (ifosfamida/ mesna/ etoposido). La doxorubicina fue reemplazada por actinomicina en el séptimo ciclo. La paciente toleró bien la quimioterapia y está clínicamente estable.

Neuroblastoma is the most common extracranial solid malignancy in children but rarely described in adults, being 10 percent of all cases diagnosed after the first decade of life. We report a 23 year-old black woman with a mass at paravertebral region of T3-T5, multiple lesions in vertebral bodies and expanding skull-brain lesion at the right parietal region. Immunohistochemical analysis (negative for CD99, CD20, CD3 and desmin; and positive chromogranin, synaptophysin and NB84) confi rmed the diagnosis of neuroblastoma. The patient was submitted to 12 cycles of chemotherapy receiving VAC (vincristine/doxorubicin/cyclophosphamide) interspersed with ICE (ifosfamide/mesna/etoposide) and doxorubicin was replaced by actinomycin in the 7th cycle. She had good tolerance to this therapy, and has been clinically stable.

Síndrome lumbociático de etiología distinta a hernia discal / Etiology of lumbosciatic syndrome different from lumbar herniated disk

La causa más frecuente de lumbociática es la hernia de disco y la patología asociada de estenosis foraminal, espondilolistesis y entesopatía de la articulación facetaria, incluyendo quistes sinoviales. Existen una serie de condiciones que pueden presentar un cuadro clínico similar, y el problema es detectar estas causas infrecuentes en un universo muy grande de pacientes con patología discal. Esto crea una situación potencialmente peligrosa, en la cual se podría interpretar la sintomatología secundaria, por ejemplo a un tumor, como producida por una hernia discal, por otro lado asintomática. En base a una historia clínica cuidadosa y al uso racional de los exámenes complementarios, se puede sospechar aquellos casos que pudieran albergar esta patología de baja incidencia, pero de gran importancia clínica. Se revisan las causas más importantes que pueden provocar un síndrome lumbociático y que deben incluirse en el diagnóstico diferencial, como el síndrome piriforme, tumores intradurales y del nervio ciático y fístulas durales.

The most frequent etiology of sciatic pain is herniation of the nucleus pulposus and associated entesopathic diseases, including synovial cysts. There are several conditions that can present with a similar clinical picture, and the clinician is confronted with the problem of detecting this infrequent occurrences. This creates a potentially dangerous condition of thinking that an asymptomatic disc herniation is causing the symptoms that are originated higher by a tumor for example. With a careful history and judicious use of ancillary examinations, specially NMR, most of the cases can be suspected. The principal causes of non-discal sciatica are reviewed, including piriform syndrome, tumors of the spine and sciatic nerve, and dural fistulae.

Spinal cord high grade astrocytoma

OBJECTIVES: To describe the medical history, psychosocial aspects and the rehabilitation management of a patient with a high-grade astrocytoma of the spinal cord. To review the literature regarding the epidemiology, classification, treatment, prognosis, and outcomes of astrocytomas involving the spinal cord. To discuss issues and controversies in the rehabilitation management of spinal cord high-grade astrocytomas. SETTING: Inpatient Spinal Cord Injury Rehabilitation Unit of Veterans Affair Medical Center; San Juan, Puerto Rico. MAIN OUTCOME MEASURES: Survival time and Functional Independence Measure (FIM) prior to and after receiving comprehensive intensive inpatient rehabilitation treatment. RESULTS: Aggressive multimodality treatment including acute inpatient interdisciplinary rehabilitation approach provided excellent results exceeding survival time and functional expectations for a patientwith high-grade astrocytoma. CONCLUSIONS: This case report stands out for two main reasons: (1) the survival time of more than three years, which exceeded the expected survival time of ten months for a patient diagnosed with spinal cord high grade astrocytoma and (2) for the outcomes achieved through an intensive comprehensive acute inpatient interdisci-plinary rehabilitation program which helped the patient achieve previous premorbid functional goals. Further studies are needed to compare these outcomes versus the ones that can be achieved through the implementation of rehabilitation management and care programs in long term care facilities such as nursing homes and hospice among others.

Tratamiento de mieloma múltiple refractario: estudio comparativo de epirubicina, vincristina y dexametasona (EVD) comparado con mitoxantrona, vincristina y dexametasona (MVD) / Treatment of refractory multiple myeloma: a comparative study of epirubicine, vincristine and dexamenthasome (EVD) as compared with misocantrone, vincristine and dexamethasone (MVD)

Teinta y cinco pacientes que tuvieron criterios de mieloma múltiple refractario (MMR) fueron seleccionados para un estudio clínico con el fin de comparar la eficacia de la combinación epirubicina, vincristina y dexametasona (EVD) comparándola con la combinación de mitoxantrona, vincristina y dexametosona (MVD). No se observaron diferencias significativas entre los dos grupos en relación a los factores pretratamiento. Once de los 18 pacientes (61 por ciento) tratados con el régimen EVD tuvieron algún tipo de respuesta, mientras que sólo seis de los 17 pacientes (35 por ciento) en el grupo MVD tuvieron respuesta. La duración de la respuesta fue mejorando en el grupo tratando con el régimen EVD (16 meses) que con el régimen MVD (7 meses). Así mismo, la duración de la supervivencia fue significativamente mayor a los que recibieron la combinación de EVD que en aquellos que recibieron el MVD 24 y 11 meses, respectivamente. La toxicidad fue moderada en ambos grupos de tratamiento y no se observaron muertes relacionadas con el tratamiento en alguno de los dos grupos. Con base en los resultados de este pequeño grupo de enfermos, se puede considerar que la administración de epirubicina en combinación con otros citotóxicos es útil en pacientes con MMR, ya que se puede observar un buen número de respuestas, con moderados efectos tóxicos. Por el contrario, no pudimos corroborar la utilidad de la mitoxantrona en combinación con otros citotóxicos y probablemente es un medicamento que deba ser considerado como de segunda línea en el tratamiento de casos con MMR

Glioblastoma multiforme primário de medula: relato de caso / Primary glioblastoma multiforme of the spinal-cord: report of a case

É apresentado um caso de glioblastoma multiforme primário em sua forma intramedular, em criança do sexo masculino com 13 anos de idade. Säo discutidos os dados da literatura e discutidos os aspectos referentes a conduta e evoluçäo do caso

Tumores raquimedulares / Spinal cord tumors

Se analizaran el cuadro clinico y los resultados del tratamiento, en especial del quirurgico, en 82 pacientes, con signos y sintomas de compresion raquimedular, ingrsados en un periodo de 10 anos. Los tumores espinales en la serie han tenido en terminos generales un comportamiento similar al de las otras series. El 16% de los tumores espinales son intramedulares, el resto es extramedular. Los tumores mas numerosos de localizacion extradural fueron las metastasis. El cuadro clinico, frecuencia de comienzo y desarrollo de la enfermedad, esta relacionado con el tipo histologico del tumor, al igual que las modificaciones en el post-operatorio. En casi todos los casos fue posible un diagnostico topografico preciso, durante el examen de ingreso. La tercera decada de la vida en adelante, fue la de mayor numero de casos, siendo el sexo masculino el mas afectado. En los tumores de localizacion, intradural extramedular, los mas numerosos fueron los meningiomas y schwamnomas; en los meningiomas, el sexo femenino fue el mas afectado. La mielografia con contraste positivo fue de gran utilidad, en el diagnostico topografico preciso. La escanografia aparece como un examen paraclinico de gran valor, en el diagnostico de los tumores del cordon espinal. Los resultados del tratameitno fueron buenos en general, y, aun casos con deficit motor acentuado mejoraron satisfactoriamente.